Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: GYN33
MultiStage: No
DXCat Label: Uterovaginal Prolapse Specificity: A
Etiology:
Degenerative; Trauma
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Relaxation of the vagina Urethrocele prolapse of the vagina
DX 6180-61809, 6185, 6187-6189;
1.02 First grade prolapse of the uterus Cervix of the uterus is within the vagina
AND not in anatomical location
AND before the ischial spine
OR first grade prolapse of the uterus
1.03 Second grade prolapse of the uterus Stage 1.02
AND cervix of the uterus is between the vaginal introitus and the ischial spine
OR second grade prolapse of the uterus
2.01 Prolapse of the uterus with rectocele or
cystocele
Stage 1.02-1.03
AND rectocele
OR cystocele
2.02 Prolapse of the uterus with enterocele Stage 1.02-1.03
AND herniation of the cul-de-sac of Douglas
2.03 Third grade prolapse of the uterus Stage 1.02-1.03
AND cervix is at the hymen
OR third grade prolapse of the uterus
2.04 Prolapse of the uterus with ulceration of
the cervix
Stage 1.02-2.03
AND ulceration of the cervix
2.05 Prolapse of the uterus with procidentia Stage 1.02-2.04
AND cervix is through the hymen
OR fourth grade prolapse of the uterus
DX 6181, 61884;
NO;
DX 6182-6184;
STAGE 1.01-1.03 + (DX 33811,
33821, 6256, 78830-78839);
DX 6186;
NO;
STAGE 1.02-2.02 + (DX 6160,
6220);
STAGE 1.02-2.04 + DX 5691;
References:
American College of Obstetricians and Gynecologists. Pelvic organ prolapse. ACOG Technical Bulletin 214. Washington, DC: ACOG 1995.
Burnett LS. Relaxations, malpositions, fistulas, and incontinence. In: Jones III HW, Wentz AC, Burnett LS, eds. Novak’s Textbook of Gynecology. 11th ed. Baltimore, MD: Williams
& Wilkins; 1988:456-458, 461.
Kistner RW. Gynecology:Principles and Practice. 4th ed. Chicago, IL: Year Book Medical Publishers. 1986:184-188.
MacKay HT. Gynecology. In: Tierney Jr LM, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis & Treatment. Stamford, CT: Appleton & Lange; 1998:691-724.
Wentz AC. Abnormal uterine bleeding. In: Jones III HW, Wentz AC, Burnett LS, eds. Novak’s Textbook of Gynecology. 11th ed. Baltimore, MD: Williams & Wilkins; 1988:378-396.
Thursday, January 07, 2010 9:22:01 AM
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